Endocrine Abstracts

Introduction: Strategies for optimising adherence in patients with growth hormone disorders often focus on enabling them to achieve autonomy in the management of their treatment, including self-injection of growth hormone (GH). However, there is a scarcity of published data on the effectiveness of this approach. We conducted a survey to elicit responses from UK endocrinologists and endocrine nurses, to investigate ‘real-world’ clinical practices around the initiation of self-injection and patient education, and to identify barriers that hinder the success of these strategies and their impact on adherence.

Methods: An online survey was distributed to 198 endocrine healthcare professionals. The survey consisted of 19 questions designed to discover the various practices across centres, and to gauge respondents’ views on the relationship between patient autonomy, GH self-injection and adherence.

Results: There were 61 responders, 42 of them nurses and 19 of them consultant endocrinologists. The majority (40) worked with paediatric patients, 17 with adult patients, and 4 with both. Optimum ages for initiating self-injection were judged to be between 7 and 10 years, although this depended on individual patients. The most common reason for initiating self-injection was a request from the child (79%), followed by parental request. Other reasons included moving to secondary education and following established centre practice. The majority of respondents (88%) thought self-injection was important and over half (54%) believed it would improve adherence. However, there was a general absence of guidelines in place to facilitate transition to self-injection. The main benefits of self-injection identified included boosting independence and confidence, taking ownership and control of treatment, and increasing patient freedom and flexibility. Barriers to achieving this included patient maturity, fear of injections or needles, poor dexterity, visual impairment, learning difficulties, parental attitudes and availability of support at home. Measures that could increase uptake in self-injection included increased nurse involvement, patient education and training, home visits, change of device and boosting parental commitment.

Conclusions: Self-injection was considered beneficial for patient well-being and likely to improve adherence, but clinicians and patients face numerous challenges. This survey highlighted some valuable issues around patient self-injection and adherence that should be explored further.